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General NPI Number Information
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NPI Number | 1972325306
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Entity Type | Organization
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Legal Business Name | ACKEILIA HEATRICE DDS PC
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 24 KIEFER CREEK ROAD
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City | ELLISVILLE
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State | MO
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Zip | 63021-6013
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Country | US
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Telephone | 636-333-9711
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Fax | 636-218-1891
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Provider Business Mailing Address
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Address Line | 24 KIEFER CREEK ROAD
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City | ELLISVILLE
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State | MO
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Zip | 63021-6013
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Country | US
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Telephone | 636-333-9711
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ACKEILIA K HEATRICE
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Credential | DDS
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Telephone | 636-333-9711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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